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Net value of multifocal IOL outweighs that of conventional monofocal IOL
J Cataract Refract Surg. 2008;34(11):1855-1861.
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The net benefit of an apodized, diffractive presbyopia-correcting multifocal IOL exceeded its cost when compared with a conventional monofocal IOL.
In a cost-benefit analysis, the multifocal IOL showed its value to select cataract patients who were willing to pay for spectacle independence.
"The expected net monetary benefit provided by the multifocal IOL was three times greater than its acquisition cost, making it a good investment for cataract patients seeking post-surgical spectacle independence," the study authors said.
The trial included 495 patients — 339 with a multifocal IOL (AcrySof model MA60D3 or SA60D3, Alcon) and 156 with a monofocal lens (AcrySof model MA60BM, Alcon). Patients' willingness to pay for spectacle independence was the benchmark for economic benefit.
Data showed that 80% of patients were willing to pay at least $5 daily for spectacle independence. The multifocal IOL had an expected benefit of $15,739 and expected cost of $4,069, yielding an expected net benefit of $11,670. The monofocal IOL had an expected benefit of $531 and expected cost of $376, producing an expected net benefit of $155. The multifocal IOL had an $11,515 advantage in net benefit.
For policy implications, this study appropriately focused on individual patients’ preferences for the new multifocal IOL technology; U.S. patients would have to choose to pay the difference in cost to obtain a multifocal IOL rather than a conventional monofocal IOL. Methodologically, the study used an existing questionnaire to elicit patients’ willingness to pay out of their own pockets for spectacle-free living. The majority of patients would pay more than $1,800 per year every year for the remainder of their lives to live spectacle-free. While the results were unvalidated (and there are reasons to question the substantial annual payment), the results suggest patients have a strong preference for spectacle-free living after cataract surgery. Physicians should explore this issue with patients when making a patient-centered decision regarding cataract surgery lens implantation.
– Kevin D. Frick, PhD
Johns Hopkins Bloomberg School of Public Health, Baltimore